TPN/Intralipids

20. Nurse Russell is preparing to give a total parenteral nutrition using a central line. Place the following steps for administration in the correct order? 1) Connect the tubing to the central line. 2) Regulate the electric infusion pump at the ordered rate. 3) Maintain aseptic technique when handling the injection cap. 4) Check the solution for cloudiness, particles, or a change in color. 5) Prime the IV tubing through an infusion pump. 6) Select and flush the correct tubing and filter. a. 4, 3, 5, 6, 1, and 2. b. 6, 4, 5, 1, 3, and 2. c. 4, 6, 5, 3, 1, and 2. d. 3, 4, 6, 1, 5, and 2.

c.

1. A patient receiving parenteral nutrition is administered via the following routes except: a. Subclavian line. b. Central Venous Catheter. c. PICC (Peripherally inserted central catheter) line. d. PEG tube.

d. Rational: Percutaneous endoscopic gastrostomy (PEG tube) is inserted into a person's stomach through the abdominal wall that is used to provide a means of feeding when oral intake is not adequate. While Parenteral nutrition bypasses the digestive system by the administration to the bloodstream.

18. A nurse is caring for a combative client who is ordered to have a nutritional therapy using parenteral nutrition (PN). The nurse should plan which of the following measures to prevent the client from injury? a. Monitor blood glucose twice a day. b. Instruct the relative to stay with the nurse. c. Measure 24-hour intake and output. d. Secure all connections in the parenteral system.

d. Rational: The nurse should plan to secure all connections in the tubing. This will prevent the client from pulling the connections apart.

9. A client is receiving parenteral nutrition (PN) in the home setting has a weight gain of 5 lb in 1 week. The nurse next assesses the client to identify the presence of which of the following? a. Hypotension. b. Crackles upon auscultation of the lungs. c. Thirst. d. Polyuria.

b. Rational: Normally, the weight gain of a client receiving PN is about 1-2 pound a week. A weight gain of 5 pounds over a week indicates a client is experiencing fluid retention that can result to hypervolemia. Signs of hypervolemia includes weight gain more than desired, headache, jugular vein distention, bounding pulse, and crackles on lung auscultation. Option A: Hypertension, not hypotension is expected. Options C and D are associated with hyperglycemia.

15. A nurse is preparing to change the parenteral nutrition (PN) solution bag and tubing. The client's central venous line is located in the right subclavian vein. The nurse ask the client to take which essential action during the tube change? a. Turn the head to the right. b. Inhale deeply, hold it, and bear down. c. Breathe normally. d. Exhale slowly and evenly.

b. Rational: The client should be asked to perform the Valsalva maneuver during tubing changes. This helps avoid air embolism during tube changes. The nurse asks the client to take a deep breath, hold it, and bear down. Option A is incorrect because if the intravenous line is on the right, the client turns his or head to the left. This position increases intrathoracic pressure. Options C and D can cause the potential for an air embolism during the tube change.

16. A nurse observes the client receiving fat emulsions is having hives. A nurse reviews the client's history and note in which of the following may cause about by the complaint of the client? a. Allergy to an egg. b. Allergy to peanut. c. Allergy to shellfish. d. Allergy to corn.

a. Rational: Fat emulsions (lipids) contain egg yolk phospholipids and should not be given to clients with egg allergies.

5. A nurse is preparing to hang a fat emulsion (lipids) and observes some visible fat globules at the top of the solution. The nurse ensure to do which of the following actions? a. Take another bottle of solution. b. Runs the bottle solution under a warm water. c. Rolls the bottle solution gently. d. Shake the bottle solution vigorously.

a. Rational: Fat emulsions are used as dietary supplements for patients who are unable to get enough fat in their diet, usually because of certain illnesses or recent surgery. The nurse should examine the bottle of fat emulsion for separation of emulsion into layers or fat globules or the accumulation of froth. The nurse should not hang a fat emulsion if any of these observed and should return the solution to the pharmacy.

10. A nurse is making initial rounds at the beginning of the shift and notice that the parenteral nutrition (PN) bag of an assigned client is empty. Which of the following solutions readily available on the nursing unit should the nurse hang until another PN solution is mixed and delivered to the nursing unit? a. 10% dextrose in water. b. 5% dextrose in water. c. 5% dextrose in normal saline. d. 5% dextrose in lactated Ringer solution.

a. Rational: The client is at risk of hypoglycemia. Hence the nurse will hang a solution that has the highest amount of glucose until the new parenteral nutrition solution becomes readily available.

12. A client is receiving parenteral nutrition (PN) suddenly is having a fever. A nurse notifies the physician and the physician initially prescribes that the solution and tubing be changed. The nurse should do which of the following with the discontinued materials? a. Send them to the laboratory for culture. b. Save them for a return to the manufacturer. c. Return them to the hospital pharmacy. d. Discard them in the unit trash.

a. Rational: When the client who is receiving PN has a high temperature, a catheter-related infection should be suspected. The solution and tubing should be changed, and the discontinued materials should be cultured for an infectious organism.

8. A client is being weaned off from parenteral nutrition (PN) and is given a go-signal to take a regular diet. The ongoing solution rate has been 120ml/hr. A nurse expects that which of the following prescriptions regarding the PN solution will accompany the diet order? a. Decrease the PN rate to 60ml/hr. b. Start 0.9% normal saline at 30 ml/hr. c. Maintain the present infusion rate. d. Discontinue the PN.

a. Rationale: When a client begins eating a regular diet after a period of receiving PN, the PN is decreased slowly. PN that is terminated abruptly will cause hypoglycemia. Gradually decreasing the infusion rate allows the client to remain sufficiently nourished during the transition to a normal diet and prevents an episode of hypoglycemia.

14. A client receiving parenteral nutrition (PN) complains of a headache. A nurse notes that the client has a bounding pulse, jugular distension, and weight gain greater than desired. The nurse determines that the client is experiencing which complication of PN therapy? a. Air embolism. b. Hypervolemia. c. Hyperglycemia. d. Sepsis.

b. Rational: Hypervolemia is a critical situation and occurs from excessive fluid administration or administration of fluid too rapidly. Clients with cardiac, renal, or hepatic dysfunction are also at risk. The client's symptoms presented in the question are consistent with hypervolemia. The increased intravascular volume increases the blood pressure whereas the pulse rate increases as the heart tries to pump the extra fluid volume. The increased volume also causes neck vein distention and shifting of fluid into the alveoli, resulting in lung crackles.

2. A nurse is monitoring the status of a client's fat emulsion (lipid) infusion and notes that the infusion is 2 hours delay. The nurse should do which of the following actions? a. Adjust the infusion rate to catch up over the next hour. b. Make sure the infusion rate is infusing at the ordered rate. c. Increase the infusion rate to catch up over the next few hours. d. Adjust the infusion rate to full blast until the solution is back on time

b. Rational: The nurse should maintain the prescribed rate of a fat emulsion even if the infusion's time consume is behind. Options A, C, and D are incorrect since increasing the rate will potentially cause a fluid overload.

13. A nurse is changing the central line dressing of a client receiving parenteral nutrition (PN) and notes that there are redness and drainage at the insertion site. The nurse next assesses which of the following? a. Time of last dressing change. b. Allergy. c. Client's temperature. d. Expiration date.

c. Rational: Redness at the catheter insertion site is a possible sign of infection. The nurse would next assess for other signs of infection. Of the options given, the temperature is the next item to assess.

11. A nurse is caring for a group of clients on a medical-surgical nursing unit. The nurse recognizes that which of the following clients would be the least likely candidate for parenteral nutrition? a. A 55-year-old with persistent nausea and vomiting from chemotherapy. b. A 44-year old client with ulcerative colitis. c. A 59-year old client who had an appendectomy. d. A 25-year old client with a Hirschprung's Disease.

c. Rational: The client with an appendectomy is not a candidate because this client would resume a regular diet within a few days following the surgery. Options A, B, and D are incorrect because parenteral nutrition is indicated in these clients since their gastrointestinal tracts are not functional or who cannot take in a diet enterally for extended periods.

19. Nurse Spencer is caring for an anorexic client who is having total parenteral solution for the first time. Which of the following assessments requires the most immediate attention? a. Dry sticky mouth. b. Temperature of 100° Fahrenheit. c. Blood glucose of 210 mg/dl. d. Fasting blood sugar of 98 mg/dl.

c. Rational: Total parenteral nutrition formula contains dextrose range from 5% to 70%. A blood glucose level of 210mg/dl is considered high.

7. A nurse is caring a client who disconnected the tubing of the parenteral nutrition from the central line catheter. A nurse suspects an occurrence of an air embolism. Which of the following is an appropriate position for the client in this kind of situation? a. On the right side, with head higher than the feet. b. On the right side, with head lower than the feet. c. On the left side, with the head higher than the feet. d. On the left side, with head lower than the feet.

d. Rational: Air embolism happens when air enters the catheter system when the IV tubing disconnects. If it is suspected, the client should be placed in a left-side-lying position. The head should be lower than the feet. This position will lessen the effect of the air traveling as a bolus to the lungs by trapping it on the right side of the heart.

17. A client receiving parenteral nutrition (PN) complains of shortness of breath and shoulder pain. A nurse notes that the client has an increased pulse rate. The nurse determines that the client is experiencing which complication of PN therapy? a. Air embolism. b. Hypervolemia. c. Hyperglycemia. d. Pneumothorax.

d. Rational: Pneumothorax might happen during a parenteral therapy due to inexact catheter placement. In order to prevent this, the nurse obtains a chest x-ray after insertion of the catheter to ensure proper catheter placement.

6. A client is receiving nutrition via parenteral nutrition (PN). A nurse assess the client for complications of the therapy and assesses the client for which of the following signs of hyperglycemia? a. High-grade fever, chills, and decreased urination. b. Fatigue, increased sweating, and heat intolerance. c. Coarse dry hair, weakness, and fatigue. d. Thirst, blurred vision, and diuresis.

d. Rational: Signs of hyperglycemia include excessive thirst, fatigue, restlessness, blurred vision, confusion, weakness, Kussmaul's respirations, diuresis, and coma when hyperglycemia is severe. Option A are signs of infection. Option B are signs of hyperthyroidism. Option C are signs of hypothyroidism.

4. A nurse is conducting a follow-up home visit to a client who has been discharged with a parenteral nutrition(PN). Which of the following should the nurse most closely monitor in this kind of therapy? a. Blood pressure and temperature. b. Blood pressure and pulse rate. c. Height and weight. d. Temperature and weight.

d. Rational: The client's temperature is monitored to identify signs of infection which is one of the complications of this therapy. While the weight is monitored to detect hypervolemia and to determine the effectiveness of this nutritional therapy.

3. A nurse is preparing to hang the initial bag of the parenteral nutrition (PN) solution via the central line of a malnourished client. The nurse ensures the availability of which medical equipment before hanging the solution? a. Glucometer. b. Dressing tray. c. Nebulizer. d. Infusion pump.

d. Rational: The nurse should prepare an infusion pump prior hanging a parenteral solution. The use of an infusion pump is important to make sure that the solution does not infuse too quickly or delayed since the parenteral nutrition has a high glucose content. Option A: A glucometer is also needed since the client's glucose level is monitored every 4 to 6 hours, but it is not an essential item needed. Options B and C are not used before hanging a PN solution.